TIP 46. Substance Abuse: Administrative Issues in Outpatient Treatment

46. TIP 46. Substance Abuse: Administrative Issues in Outpatient Treatment

Title Page
Treatment Improvement Protocol (TIP) Series

Robert F. Forman, Ph.D.
Consensus Panel Chair
Paul D. Nagy, M.S., LCAS, LPC, CCS
Consensus Panel Co-Chair
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
1 Choke Cherry Road
Rockville, MD 20857

Acknowledgments

Numerous people contributed to the development of this Treatment Improvement Protocol (TIP) (see below and appendixes B, C, and D). This publication was produced by JBS International, Inc. (JBS), under the Knowledge Application Program (KAP) contract numbers 270-99-7072 and 270-04-7049 with the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (DHHS). Christina Currier served as the Center for Substance Abuse Treatment (CSAT) Government Project Officer, and Andrea Kopstein, Ph.D., M.P.H., served as Deputy Government Project Officer. Lynne MacArthur, M.A., A.M.L.S., served as the JBS KAP Executive Project Co-Director. Barbara Fink, RN, M.P.H., served as the JBS KAP Managing Project Co-Director. Other JBS KAP personnel included Dennis Burke, M.S., M.A., and Emily Schifrin, M.S., Deputy Directors for Product Development; Patricia A. Kassebaum, M.A., Senior Writer; Elliott Vanskike, Ph.D., Senior Writer/Publication Manager; Wendy Caron, Editorial Quality Assurance Manager; Frances Nebesky, M.A., Quality Assurance Editor; Leah Bogdan, Junior Editor; and Pamela Frazier, Document Production Specialist. In addition, Sandra Clunies, M.S., ICADC, served as Content Advisor. Dixie M. Butler, M.S.W., and Paddy Shannon Cook were writers.

Disclaimer

The opinions expressed herein are the views of the consensus panel members and do not necessarily reflect the official position of CSAT, SAMHSA, or DHHS. No official support of or endorsement by CSAT, SAMHSA, or DHHS for these opinions or for particular instruments, software, or resources described in this document is intended or should be inferred. The guidelines in this document should not be considered substitutes for individualized client care and treatment decisions.

Public Domain Notice

All materials appearing in this volume except those taken directly from copyrighted sources are in the public domain and may be reproduced or copied without permission from SAMHSA/CSAT or the authors. Do not reproduce or distribute this publication for a fee without specific, written authorization from SAMHSA's Office of Communications.

Electronic Access and Copies of Publication

Copies may be obtained free of charge from SAMHSA's National Clearinghouse for Alcohol and Drug Information (NCADI), (800) 729-6686 or (301) 468-2600; TDD (for hearing impaired), (800) 487-4889; or electronically through www.ncadi.samhsa.gov.

Recommended Citation

Center for Substance Abuse Treatment. Substance Abuse: Administrative Issues in Outpatient Treatment. Treatment Improvement Protocol (TIP) Series 46. DHHS Publication No. (SMA) 06-4151. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2006.

Originating Office
Practice Improvement Branch, Division of Services Improvement, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857.

DHHS Publication No. (SMA) 06-4151
NCADI Publication No. BKD545
Printed 2006

What Is a TIP?

Treatment Improvement Protocols (TIPs), developed by the Center for Substance Abuse Treatment (CSAT), part of the Substance Abuse and Mental Health Services Administration (SAMHSA), within the U.S. Department of Health and Human Services (DHHS), are best-practice guidelines for the treatment of substance use disorders. CSAT draws on the experience and knowledge of clinical, research, and administrative experts to produce the TIPs, which are distributed to facilities and individuals across the country. The audience for the TIPs is expanding beyond public and private treatment facilities to include practitioners in mental health, criminal justice, primary care, and other health care and social service settings.

CSAT's Knowledge Application Program (KAP) expert panel, a distinguished group of experts on substance use disorders and professionals in such related fields as primary care, mental health, and social services, works with the State Alcohol and Drug Abuse Directors to generate topics for the TIPs. Topics are based on the field's current needs for information and guidance.

After selecting a topic, CSAT invites staff from pertinent Federal agencies and national organizations to be members of a resource panel that recommends specific areas of focus as well as resources that should be considered in developing the content for the TIP. These recommendations are communicated to a consensus panel composed of non-Federal experts on the topic who have been nominated by their peers. Consensus panel members participate in a series of discussions. The information and recommendations on which they reach consensus form the foundation of the TIP. The members of each consensus panel represent substance abuse treatment programs, hospitals, community health centers, counseling programs, criminal justice and child welfare agencies, and private practitioners. A panel chair (or co-chairs) ensures that the content of the TIP mirrors the results of the group's collaboration.

A large and diverse group of experts closely reviews the draft document. Once the changes recommended by these field reviewers have been incorporated, the TIP is prepared for publication, in print and on line. TIPs can be accessed via the Internet at www.kap.samhsa.gov. The online TIPs are consistently updated and provide the field with state-of-the-art information.

Although each TIP strives to include an evidence base for the practices it recommends, CSAT recognizes that the field of substance abuse treatment is evolving, and research frequently lags behind the innovations pioneered in the field. A major goal of each TIP is to convey “front-line” information quickly but responsibly. For this reason, recommendations proffered in the TIP are attributed to either panelists' clinical experience or the literature. If research supports a particular approach, citations are provided.

This TIP, Substance Abuse: Administrative Issues in Outpatient Treatment, was written to help administrators work in the changing environment in which outpatient treatment programs operate. The TIP provides basic information about running an outpatient treatment program, including strategic planning, working with a board of directors, relationships with strategic partners, hiring and retaining employees, staff supervision, continuing education and training, performance improvement, outcomes monitoring, and promotion of the program to potential clients, funding agencies, and government officials. More specialized sections address challenges that have emerged and gathered importance in the last decade: preparing a program to provide culturally competent treatment to an increasingly diverse client population, succeeding in a managed care-dominated world by diversifying the funding sources a program draws on, and understanding privacy and confidentiality requirements imposed by Federal legislation.

Consensus Panel

This TIP is a consensus-based document, developed by the experts listed below. Although all panelists made significant contributions in the development of the TIP as a whole, some panelists took on the additional responsibility as writers for upfront development of particular chapters. Those chapters are listed after their names.

Chair

Robert F. Forman, Ph.D.
Clinical Scientist
Medical Affairs
Alkermes, Inc.
Cambridge, Massachusetts
Formerly
Senior Investigator
Treatment Research Institute and
Assistant Professor of Psychology in Psychiatry
School of Medicine
University of Pennsylvania
Philadelphia, Pennsylvania
Writer, chapters 1, 2, 3, 5, and 6
Co-Chair


Paul D. Nagy, M.S., LCAS, LPC, CCS
Program Director
Duke Addictions Program
Clinical Associate
Department of Psychiatry and Behavioral Sciences
Duke University Medical Center
Durham, North Carolina
Writer, chapters 1 and 2
Consensus Panelists


Fred Andes, D.S.W., M.P.A., LCSW
Assistant Professor of Sociology
New Jersey City University
Jersey City, New Jersey


Margaret K. Brooks, J.D.
Consultant
27 Warfield Street
Montclair, New Jersey


Frederick T. Chappelle, M.S.S.W., LCADC, CCS
Vice President and Financial Officer
Chappelle Consulting and Training Services, Inc.
Middletown, Connecticut
Writer, chapters 3 and 4


Gerard J. Connors, Ph.D.
Director
Research Institute on Addictions
University of Buffalo
Buffalo, New York


Anita L. Crawford
Chief Executive Officer
Roxbury Comprehensive Community Health Center
Roxbury, Massachusetts


Chris B. Farentinos, M.D., CADC II, NCDC II
Clinical Director
Change Point, Inc.
Portland, Oregon
Writer, chapter 4


Marco E. Jacome, M.A., LPC, CSADC, CEAP
Executive Director
Healthcare Alternative Systems, Inc.
Chicago, Illinois
Writer, chapter 4


George Kolodner, M.D.
Medical Director
Kolmac Clinic
Silver Spring, Maryland


Felicity L. LaBoy, Ph.D.
Clinical Coordinator
Dual Diagnoses Program
Substance Abuse Services
Bronx VA Medical Center
Bronx, New York


Janice Ogden Lipscomb, M.S., ACADC
Director
Mental Health and Chemical Dependency Community Based Programs
Broadlawns Medical Center
Des Moines, Iowa


Mary E. McCaul, Ph.D.
Associate Professor
Psychiatry and Behavioral Sciences
Johns Hopkins University School of Medicine
Baltimore, Maryland


Elizabeth A. Peyton
Principal
Peyton Consulting Services
Newark, Delaware


Richard A. Rawson, Ph.D.
Associate Director
UCLA Integrated Substance Abuse Programs
Los Angeles, California


Candace M. Shelton, M.S., CSAS, CADAC, CCS
Consultant
Tucson, Arizona
KAP Expert Panel and Federal Government Participants


Barry S. Brown, Ph.D.
Adjunct Professor
University of North Carolina at Wilmington
Carolina Beach, North Carolina


Jacqueline Butler, M.S.W., LISW, LPCC, CCDC III, CJS
Professor of Clinical Psychiatry
College of Medicine
University of Cincinnati
Cincinnati, Ohio


Deion Cash
Executive Director
Community Treatment and Correction Center, Inc.
Canton, Ohio


Debra A. Claymore, M.Ed.Adm.
Owner/Chief Executive Officer
WC Consulting, LLC
Loveland, Colorado


Carlo C. DiClemente, Ph.D.
Chair
Department of Psychology
University of Maryland Baltimore County
Baltimore, Maryland


Catherine E. Dube, Ed.D.
Independent Consultant
Brown University
Providence, Rhode Island


Jerry P. Flanzer, D.S.W., LCSW, CAC
Chief, Services
Division of Clinical and Services Research
National Institute on Drug Abuse
Bethesda, Maryland


Michael Galer, D.B.A.
Chairman of the Graduate School of Business
University of Phoenix—Greater Boston Campus
Braintree, Massachusetts


Renata J. Henry, M.Ed.
Director
Division of Alcoholism, Drug Abuse, and Mental Health
Delaware Department of Health and Social Services
New Castle, Delaware


Joel Hochberg, M.A.
President
Asher & Partners
Los Angeles, California


Jack Hollis, Ph.D.
Associate Director
Center for Health Research
Kaiser Permanente
Portland, Oregon


Mary Beth Johnson, M.S.W.
Director
Addiction Technology Transfer Center
University of Missouri-Kansas City
Kansas City, Missouri


Eduardo Lopez, B.S.
Executive Producer
EVS Communications
Washington, D.C.


Holly A. Massett, Ph.D.
Academy for Educational Development
Washington, D.C.


Diane Miller
Chief
Scientific Communications Branch
National Institute on Alcohol Abuse and Alcoholism
Bethesda, Maryland


Harry B. Montoya, M.A.
President/Chief Executive Officer
Hands Across Cultures
Espanola, New Mexico


Richard K. Ries, M.D.
Director/Professor
Outpatient Mental Health Services
Dual Disorder Programs
Seattle, Washington


Gloria M. Rodriguez, D.S.W.
Research Scientist
Division of Addiction Services
New Jersey Department of Health and Senior Services
Trenton, New Jersey


Everett Rogers, Ph.D.
Center for Communications Programs
Johns Hopkins University
Baltimore, Maryland


Jean R. Slutsky, P.A., M.S.P.H.
Senior Health Policy Analyst
Agency for Healthcare Research and Quality
Rockville, Maryland


Nedra Klein Weinreich, M.S.
President
Weinreich Communications
Canoga Park, California


Clarissa Wittenberg
Director
Office of Communications and Public Liaison
National Institute of Mental Health
Bethesda, Maryland
Consulting Members to the KAP Expert Panel



Paul Purnell, M.A.
Social Solutions, L.L.C.
Potomac, Maryland


Scott Ratzan, M.D., M.P.A., M.A.
Academy for Educational Development
Washington, D.C.


Thomas W. Valente, Ph.D.
Director, Master of Public Health Program
Department of Preventive Medicine
School of Medicine
University of Southern California
Alhambra, California


Patricia A. Wright, Ed.D.
Independent Consultant
Baltimore, Maryland
Foreword

The Treatment Improvement Protocol (TIP) series supports SAMHSA's mission of building resilience and facilitating recovery for people with or at risk for mental or substance use disorders by providing best-practices guidance to clinicians, program administrators, and payers to improve the quality and effectiveness of service delivery and thereby promote recovery. TIPs are the result of careful consideration of all relevant clinical and health services research findings, demonstration experience, and implementation requirements. A panel of non-Federal clinical researchers, clinicians, program administrators, and client advocates debates and discusses its particular areas of expertise until it reaches a consensus on best practices. This panel's work is then reviewed and critiqued by field reviewers.

The talent, dedication, and hard work that TIPs' panelists and reviewers bring to this highly participatory process have helped bridge the gap between the promise of research and the needs of practicing clinicians and administrators who serve, in the most current and effective ways, people who abuse substances. We are grateful to all who have joined with us to contribute to advances in the substance abuse treatment field.

Charles G. Curie, M.A., A.C.S.W.
Administrator
Substance Abuse and Mental Health Services Administration

H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM
Director
Center for Substance Abuse Treatment
Substance Abuse and Mental Health Services Administration

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